Senior Compliance Coding Auditor

This is a fully remote position, open to applicants in Texas.

📋 Description

• Perform audits on billing and coding practices.

• Execute both prospective and retrospective chart reviews, ensuring medical record documentation aligns with reported CPT/HCPCS and ICD codes.

• Detect discrepancies in coding and propose recommendations for enhancements.

• Relay audit outcomes and findings to healthcare providers and/or ancillary personnel, sharing ideas for improvement.

• Offer ongoing education to providers and ancillary staff regarding CPT/HCPCS and ICD-9/10 coding standards.

• Uphold compliance with governmental (Medicare & Medicaid) and private payer regulations.

• Collaborate closely with all departments to ensure the accuracy of reported services and to assist in chart reviews.

• Inform the Compliance Officer about updates to government coding and billing guidelines and regulations.

⛳️ Requirements

• High School Diploma or equivalent, along with 5 years of relevant experience.

• Certification as a Professional Coder (CPC®) from AAPC OR as a Certified Coding Specialist (CCS®) from AHIMA is mandatory.

• A minimum of 5 years of experience within a medical office or healthcare setting.

• At least 5 years of experience in procedural and diagnostic coding.

• Comprehensive understanding of current industry trends, particularly in relation to Medicare, Texas Medicaid, and national coding updates.

• In-depth knowledge of Centers for Medicare & Medicaid Services (CMS) regulations.

• Proficient in the accurate application of CPT, HCPCS procedure, and ICD-10-CM diagnosis codes for medical claims coding and billing.

• Strong familiarity with medical terminology, disease processes, and pharmacology.

• Excellent attention to detail and precision.

🏝️ Benefits

• Health insurance.

• 401(k) matching.

• Paid time off.

• Flexible work arrangements.

• Professional development opportunities.